Intra-Oral Hard Tissues

With aging, the enamel of the teeth is subjected to mechanical and chemical wear. It becomes more brittle which may result in hairline fractures. Undermining decay and/or previously placed fillings may also cause fractures in older teeth. Aging enamel loses its surface texture and appears flatter and more yellowed. Staining can also be caused by food, drugs, tobacco products, poor oral hygiene, necrotic pulpal tissue, arrested decay and corrosion products from filling material. To see a graphic illustration of the anatomy of a tooth, click the link.

The roots of aging teeth may appear glass like. Changes in the aging pulp make the tooth less sensitive and diminished blood flow slows the healing potential. The root surface of the tooth is covered with cementum that triples in thickness between the ages of ten and seventy-five (Zander & Hrzeler 1958). Receding gingival tissue may expose the altered (i.e. thicker) cementum and eventually lead to loss of the tooth due to periodontal disease.

Root Surface of an Older Adult

Osteorporotic changes with advancing age also occur in the bones that surround the oral cavity. The bone becomes more brittle and less dense. Edentulous bony ridges become atrophic and dentures may need to be modified to compensate for the shrinking ridge. Ill-fitting dentures may accelerate the resorption of bone, and leave a fibrotic (dense) soft tissue ridge, referred to as flaccid ridge. Declining bony ridges can make the wearing of dentures increasingly difficult, especially in combination with a decline in the muscular control that is needed to accommodate a denture. This is especially true of dentures for the lower jaw.

Resorbed Ridge of an Older Adult

The jaw joint is called the temporomandibular joint (TM joint). It may be affected by osteoarthrithis or rheumatoid arthritis. Wear-related damage to the joint and/or perforation of the cartilage disc within the joint may cause the joint to make noise, cause irregular movement and at times may lead to pain during jaw movement or at rest.

Dysphagia (i.e. difficulty with swallowing) is associated with a number of neuromuscular conditions seen in the elderly. It may result in malnutrition and dehydration (Hellemans et al, 1984) and increases the risk of aspiration pneumonia.

Acid reflux, commonly referred to as heartburn, creates an acidic oral environment that can erode the enamel surfaces of the teeth, thus increasing the risk of decay and potentially leading to sensitivity from exposed dentinal surfaces. Medications that eliminate heartburn invariably decrease salivation.